Provider Demographics
NPI:1275708497
Name:BLANKER, KATHRYN AUGUSTA (MSW)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:AUGUSTA
Last Name:BLANKER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 TRI PARK WAY
Mailing Address - Street 2:BLDG 2
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54914-6430
Mailing Address - Country:US
Mailing Address - Phone:920-831-0070
Mailing Address - Fax:
Practice Address - Street 1:14 TRI PARK WAY
Practice Address - Street 2:BLDG 2
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-6430
Practice Address - Country:US
Practice Address - Phone:920-831-0070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1088-1211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical